Contact Number Name Current Address Housing Needed By Approximate Time Housing Will Be Needed Indefinitely 1-3 Months 3-6 Months 6-9 Months 1 Year or More Your Employer/ Dept./ Section or Unit Rank, if applicable Work Status ADSW AGR Civilian State Active Duty Federal Tech Total Number of dependents to be housed with you Relationship (Spouse, Child, etc.) Dependent's Date of Birth Dependents Names Circumstances for requesting housing. List Number and Type of Any Pets You Have.

DISCLAIMER NOTICE: IF YOU CLICK "SUBMIT" AT THE BOTTOM OF THIS PAGE , YOU WILL BE SENT TO A PAGE THAT CONTAINS PRINTABLE NOTICE   THAT YOUR REQUEST HAS BEEN SUBMITTED. HOWEVER, THIS DOES NOT GUARANTEE THAT WE CAN SUPPORT YOUR REQUEST. PLEASE KEEP A COPY OF THE REQUEST SUBMISSION FORM FOR YOUR RECORDS. WE SHOULD RECEIVE AN ELECTRONIC COPY OF YOUR REQUEST WHEN YOU CLICK ON THE "SUBMIT" BUTTON, BUT ON OCCASION, REQUESTS DO NOT GO THROUGH FOR ONE REASON OR ANOTHER. THUS, IF YOU ARE NOT CONTACTED WITH CONFIRMATION CONCERNING YOUR REQUEST WITHIN TWO BUSINESS DAYS, PLEASE CONTACT OUR HOUSING DEPARTMENT AT (225) 319-4675. THANK YOU!